Doctors feel they have no choice but to work despite mental wellbeing concerns

Nearly three quarters (73%) of doctors in the UK say they have continued to work despite not feeling mentally well enough to do so - due to staff shortages, the guilt of putting pressure on colleagues, and because it is just what is expected of them. More than a quarter (27%) say taking time off for mental wellbeing issues is not “acceptable” where they work.

Medical Protection Society (MPS) surveyed over 1000 doctors in the UK on presenteeism in the medical workforce and the factors driving it. Three in five (60%) say they have continued to work when not feeling mentally well enough because they feel guilty adding to colleagues’ workloads, and half (50%) cite staff shortages. 47% say it is what is expected, and two in five (42%) say it because their patients rely on them.

Anonymous comments left by the doctors surveyed, also indicate that some struggle into work due to the “shame” at having to state mental wellbeing as a reason for their absence, and because they are fearful it will jeopardise career progression.

Doctors who participated said working despite not feeling mentally well enough had led to a lack of empathy with patients (63%), a loss of concentration (63%) or practising defensive medicine (42%). Almost half (46%) suspected it may have contributed to a lower standard of care, and 12% said it may have resulted in a missed or incorrect diagnosis. 19% said there had been no effect on patients.

MPS, which represents the professional interests of over 300,000 healthcare professionals around the world, called for more to be done to ensure doctors can take time off for mental wellbeing issues “without guilt, fear or stigma”, and said the abolition of NHS England must not delay the implementation of a plan that ensures support services are properly funded.

Professor Dame Jane Dacre, MPS President, said: “Doctors are notoriously reluctant to take time off when they feel unwell, and will put their patients’ and colleagues’ needs before their own.

“It is concerning however, that so many doctors continue to work despite not feeling mentally well enough to do so. If they do not feel they can take time off to recuperate or seek support - due to staff shortages or cultural expectation - this could exacerbate the issue, result in them taking more time off in the long term, or even leaving the profession.

“Working despite not being mentally well enough so can also impact on patient care and the survey indicates the variety of ways this could manifest - from lack of empathy and concentration, right through to a missed diagnosis.

“What is particularly disappointing is that over a quarter of doctors feel that taking time off for mental wellbeing issues is not acceptable where they work. Clearly much more needs to be done to enable and support all healthcare workers to take time off when they are too unwell to work - without guilt, fear or stigma.

“Accessible mental wellbeing support is key here, and in our survey 89% say better access to support could reduce presenteeism. Those working in the NHS should at least have counselling and peer support networks available to them when they need it, to tackle issues early on and enable them to continue to care for patients safely.

“Healthcare workers should also have access to confidential, specialist help outside of their place of work, without fear of repercussion from their employers. We know national services like NHS Practitioner Health – which has funding until Spring 2026 - provide a vital lifeline for many who are struggling to cope.

“One year ago, NHS England initiated a review into the provision of mental wellbeing support for NHS staff. The abolition of NHS England and the restructuring of how the NHS is managed, must not hold up a plan being implemented that ensures support services are properly funded and safeguarded. Investment in comprehensive mental wellbeing support can play a critical role in retaining the medical workforce and requires swift and long-term thinking.”

Commenting on MPS’s findings, Dr Roman Raczka, President of the British Psychological Society, said:

“It is vital we protect the mental health and wellbeing of those who care for us when we are most in need. These findings sadly show that this is still not being achieved. With the unrelenting pressure of increasing workloads and the prospect of major health service reform, after one of the busiest winters on record, we shouldn't underestimate the psychological toll this can potentially cause. 

“It’s extremely worrying that a culture of silence and stigma remains for medics experiencing mental health challenges. For the sake of staff wellbeing and patient care, long-term investment in dedicated mental health support for staff is urgently needed now more than ever.”

Doctors who participated in the MPS survey commented anonymously:

“My main concern is that patients will not get the best version of me looking after them.”

“Cultural expectation is made clear during training to continue working when unwell. The problem is the workload is so great that you know your absence will cause unmanageable workloads for your colleagues and leave them potentially practising in an unsafe manner.”

“I have suffered with stress/anxiety and although I have taken time off work in the past I usually wait until things are very bad, because I feel bad about letting partners/patients down.”

“You are struggling the day and night before your shift, and you’ve cried the entire night, but you can’t call in sick. Because when they ask you what’s the reason for calling in sick, no one wants to say it’s a personal reason with mental health. Instead, you opt to go work.”

“Shame at having to give a reason and explain why I’m taking time off.”

“Fear of being labelled. Fear of losing training opportunities.”

“Management have said there is mental health support available, however it’s for a very short period at a specific time for a couple hours on a specific day. I think this is very limited. It’s difficult to keep mental health struggles limited to a specific time and day.”

“It has become normal to feel very low or tearful on the approach to work, or once in the workplace. It’s so common amongst colleagues it feels pointless to complain now.”

“There is a pervasive fear among professionals that speaking up about challenges, including mental health concerns, can jeopardize career progression.”

“We are just expected to give more and more, no matter the mental cost.”

“My manager will ask us to work from home rather than be off sick. It makes it a harder working day than being in work. I therefore get more worried about calling in sick as if I'm unwell I'm not well enough to deal with that question.”

“Given that the system is facing near collapse, there is an unwritten sense of obligation to put in both extra hours and come to work when you might not be feeling well. If this was any other industry, I would not feel guilty taking time off, but as we are dealing with some of the most important moments in people’s lives and knowing that might not be anybody else to help them, it does tend to push you into work. Essentially what I’m saying is, the NHS runs on goodwill and guilt at the moment.”

“When working while mentally unwell, I tend to struggle more with decision making and my reflex is to take longer or follow up more or investigate more. This can over medicalise someone and tends to increase my workload and risk of burnout.”

“Increased anxiety around making mistakes, either in diagnosis, or management. Also concerns around the increased adverse effect on my mental health which then becomes a vicious circle.”

“I don't think I put patients at risk. It's more that I am causing my mental health to deteriorate further.”

“If I am exhausted and can't think properly, how am I supposed to make reliable decisions that affect people's lives?”

MPS counselling support service
Confidential counselling sessions and wellbeing resources are included as one of the benefits of MPS membership at no additional cost. To access the confidential counselling see www.medicalprotection.org/uk/wellbeing

For further information contact [email protected]

1075 MPS members participated in the survey which took place in January 2025. Key findings:

• 73% of respondents said they have gone to work, or continued to work, despite not feeling mentally well enough to do so
• 60% have done so because they felt guilty adding to colleagues’ workloads
• 50% have done so because of staff/rota shortages
• 47% have done so because it is what is expected of the medical profession
• 42% have done so because their patients rely on them
• 27% have done so because of pressure to clear waiting lists
• 27% of respondents said taking time off work for mental wellbeing issues was not considered acceptable at their work
• 89% said working while not feeling mentally well enough to do so has made them feel more burnt out and exhausted
• 63% said has contributed to a lack of empathy with patients
• 63% said it has contributed to a loss of concentration
• 59% said it has contributed to them being more fearful of making mistakes
• 48% said it has contributed to them practicing defensive medicine
• 30% said has contributed to an increased concern about medicolegal issues
• 32% said it has contributed to a breakdown in relationships or conflict with colleagues
• 28% said it has contributed to a negative impact on team functionality
• 46% said it may have contributed to a lower standard of patient care
• 12% said it may have contributed to a missed or incorrect diagnosis
• 19% said there had been no effect on patients
• 94% said introducing measures to ensure the healthcare system has the capacity to allow doctors time off if needed may reduce instances of presenteeism
• 89% said better access to mental wellbeing support and resources would help to reduce presenteeism.

About MPS

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